Influence Of Experience And The Surgical Learning Curve On Outcomes Of Implantable Collamer Lens Surgery

The purpose of this study was to investigate the effect of different level of expertise on the long term outcome of ICL surgery and to highlights the necessity of training for fellows on ICL implantation techniques to improve the outcome of the procedure .

King Khaled Eye Specialist Hopsital ,Riyadh ,Saudi Arabia 

Retrospective chart review of all patients (21-45 years old) who underwent ICL surgery for myopia, compound myopic astigmatism between January 2015 and December 2018. Patients who underwent ICL for hyperopia,keratoconus or post keratoplasty were excluded. Pre-operative, operative and post-operative data for each procedure were collected. Outcomes were  compared based upon whether the primary surgeon  for the procedure was a  fellow (group1) or  an attending staff (group 2).The primary outcome measure was the development of cataract or endothelial cell loss; The secondary outcome measure was visual acuity at each follow-up visit.

183eyes of115patients underwent ICL surgery for myopia.Mean(±SD)spherical equivalent for patients who were operated by fellows vs.consultant were -9.74±3.51and -10.02± 3.80.Median follow up time(IQR)for patients operated by fellows and consultants was31.50(32)month and 28(33)months.There was no statistically significant difference in median percent change in ECC between the two groups(p=0.812).Median(IQR)percent decrease in ECC at the last follow up from baseline for eyes operated by fellows was3.97(7)compared with3.79(4)for eyes operated by the consultants.Seven (3.8%)patients developed cataract during follow up time.Final VA of these eyes was0.00 to 0.40.

ICL implantation provided good refractive outcomes and stability in the long term.There was no significant difference in  post-operative ECC loss,cataract development or complications with different level of expertise